Department of Veterans Affairs Pt. 4, App. B

Total Page:16

File Type:pdf, Size:1020Kb

Department of Veterans Affairs Pt. 4, App. B Department of Veterans Affairs Pt. 4, App. B Sec. Sec. Diagnostic Code 7111—NOTE; September 9, Diagnostic Code 7907—60% Evaluation; August 1975. 13, 1981. Diagnostic Codes 7114, 7115, 7116, and NOTE; Diagnostic Code 7909—40% and 20% Evalua- June 9, 1952. tion; August 13, 1981. Diagnostic Code 7117 and NOTE; June 9, 1952. Diagnostic Code 7911—Evaluations and Note; NOTE following Diagnostic Code 7120; July 6, March 1, 1963; 40% and 20% Evaluations; 1950. August 13, 1981. Diagnostic Code 7121—100 percent Criterion Diagnostic Code 7913—Note; September 9, and Evaluation and 60 percent Criterion; 1975. March 10, 1976. Criteria for 30 percent and Diagnostic Code 7914—Note; March 10, 1976. 10 percent and NOTE; July 6, 1950. 4.122 October 1, 1961. Last sentence of NOTE following Diagnostic 4.124a Diagnostic Code 8002, NOTE; Code 7122; July 6, 1950. Diagnostic Code 8021, NOTE; 4.114 Diagnostic Codes 7304 and 7305—Evaluations; Diagnostic Code 8045; October 1, 1961. November 1, 1962. Diagnostic Code 8046; October 1, 1961. Diagnostic Code 7308—Evaluations; April 8, Diagnostic Code 8100—Evaluations; June 9, 1959. 1953. Diagnostic Code 7312—70% Evaluation and 50% Evaluation and Criterion; March 10, Diagnostic Codes 8910 through 8914; October 1976. 1, 1961. Diagnostic Code 7313—20% Evaluation; March Diagnostic Codes 8910 through 8914 General 10, 1976. Rating Formula—Criteria and Evaluations; Diagnostic Code 7319—Evaluations; November September 9, 1975. 1, 1962. 4.125– All Diagnostic Codes under Mental Disorders; Diagnostic Code 7321—Evaluations and Note; 4.132 October 1, 1961, except as to evaluation for July 6, 1950. Diagnostic Codes 9500 through 9511; Sep- Diagnostic Code 7328—Evaluations and Note; tember 9, 1975. November 1, 1962. Diagnostic Code 7329—Evaluations and Note; November 1, 1962. [29 FR 6718, May 22, 1964, as amended at 34 Diagnostic Code 7330—60% Evaluation; No- FR 5064, Mar. 11, 1969; 40 FR 42541, Sept. 15, vember 1, 1962. 1975; 41 FR 11291, Mar. 18, 1976; 41 FR 34258, Diagnostic Code 7332—60% Evaluation; No- Aug. 13, 1976; 43 FR 45362, Oct. 2, 1978; 46 FR vember 1, 1962. 43666, Aug. 31, 1981; 52 FR 44122, Nov. 18, 1987; Diagnostic Code 7334—50% and 30% Evalua- 52 FR 46439, Dec. 7, 1987] tions; July 6, 1950. Diagnostic Code 7334—10% Evaluation; No- vember 1, 1962. APPENDIX B TO PART 4—NUMERICAL Diagnostic Code 7339—Criterion for 20% Eval- INDEX OF DISABILITIES uation; March 10, 1976. [ACUTE, SUBACUTE, OR CHRONIC DISEASES] Diagnostic Code 7343—Note; March 10, 1976. Diagnostic Code 7345—100%, 60% and 30% Diag- Evaluations; August 23, 1948. nos- Diagnostic Code 7345—10% Evaluation; Feb- tic ruary 17, 1955. Code Diagnostic Code 7345—10% Evaluation; Feb- No. ruary 17, 1955. Diagnostic Code 7346—Evaluations; February 5000 Osteomyelitis, acute, subacute, or chronic. 1, 1962. 5001 Bones and Joints, tuberculosis of. Diagnostic Code 7347; September 9, 1975. 5002 Arthritis, rheumatoid (atrophic). Diagnostic Code 7348; March 10, 1976. 5003 Arthritis, degenerative, hypertrophic, or osteoarthritis. 4.115a Diagnostic Code 7500—Note; July 6, 1950. 5004 Arthritis, gonorrheal. Diagnostic Code 7519—20%, 40% and 60% 5005 Arthritis, pneumococcic. Evaluations; March 10, 1976. 5006 Arthritis, typhoid. Diagnostic Code 7524—Note; July 6, 1950. 5007 Arthritis, syphilitic. Diagnostic Code 7528—Note; March 10, 1976. 5008 Arthritis, streptococcic. Diagnostic Code 7530; September 9, 1975. 5009 Arthritis, other types. Diagnostic Code 7531; September 9, 1975. 5010 Arthritis, due to trauma. 4.116a Diagnostic Code 7627—Note; March 10, 1976. 5011 Bones, caisson disease of. 4.117 Diagnostic Code 7703—Evaluations; August 23, 5012 Bones, new growths of, malignant. 1948. 5013 Osteoporosis, with joint manifestations. Diagnostic Code 7709—Note; March 10, 1976. 5014 Osteomalacia. Evaluations; June 9, 1952. 5015 Bones, new growths of, benign. Diagnostic Code 7714; September 9, 1975. 5016 Osteitis deformans. 4.118 Diagnostic Code 7801—Note (2); July 6, 1950. 5017 Gout. Diagnostic Code 7804—Note; July 6, 1950. 5018 Hydrarthrosis, intermittent. 4.119 Diagnostic Code 7900—10% Evaluation; and Notes (2) and (3); August 13, 1981. 5019 Bursitis. Diagnostic Code 7902—20% Evaluation; August 5020 Synovitis. 13, 1981. 5021 Myositis. Diagnostic Code 7903—10% Evaluation; August 5022 Periostitis. 13, 1981. 5023 Myositis ossificans. Diagnostic Code 7905—10% Evaluation; August 5024 Tenosynovitis. 13, 1981. 423 VerDate 11<MAY>2000 11:56 Jul 18, 2001 Jkt 194134 PO 00000 Frm 00423 Fmt 8010 Sfmt 8002 Y:\SGML\194134T.XXX pfrm11 PsN: 194134T Pt. 4, App. B 38 CFR Ch. I (7–1–01 Edition) [ACUTE, SUBACUTE, OR CHRONIC DISEASES] [ACUTE, SUBACUTE, OR CHRONIC DISEASES] Diag- Diag- nos- nos- tic tic Code Code No. No. COMBINATIONS OF DISABILITIES 5164 With loss of natural knee action. 5165 At a lower level. 5100 Anatomical loss of both hands and both feet. 5166 Forefoot, amputation proximal to metatarsal bones. 5101 Loss of use of both hands and both feet. 5167 Foot, loss of use of. 5102 Anatomical loss of both hands and one foot. 5170 Toes, all, amputation of, without metatarsal loss. 5103 Anatomical loss of both feet and one hand. 5171 Toe, great, amputation of. 5104 Loss of use of both hands and one foot. 5172 Toe, other, amputation of. 5105 Loss of use of both feet and one hand. 5173 Toes, three or more, amputation of, not including 5106 Anatomical loss of both hands. great toe. 5107 Anatomical loss of both feet. 5108 Anatomical loss of one hand and one foot. THE SHOULDER AND ARM 5109 Loss of use of both hands. 5110 Loss of use of both feet. 5200 Scapulohumeral articulation, ankylosis of. 5111 Loss of use of one hand and one foot. 5201 Arm, limitation of motion of. 5202 Humerus, other impairment of. AMPUTATIONS: UPPER EXTREMITY 5203 Clavicle or scapula, impairment of. Arm, amputation of: THE ELBOW AND FOREARM 5120 Disarticulation. 5121 Above insertion of deltoid. 5205 Elbow, ankylosis of. 5122 Below insertion of deltoid. 5206 Forearm, limitation of flexion of. Forearm, amputation of: 5207 Forearm, limitation of extension of 5123 Above insertion of pronator teres. 5208 Forearm, flexion limited to 100° and extension to 45°. 5124 Below insertion of pronator teres. 5209 Elbow, other impairment of. 5125 Hand, loss of use of. 5210 Radius and ulna, nonunion of, with flail false joint. 5126 Five digits of one hand, amputation of: 5211 Ulna, impairment of. Four digits of one hand, amputation of: 5212 Radius, impairment of. 5127 Thumb, index, middle and ring. 5213 Supination and pronation, impairment of. 5128 Thumb, index, middle and little. 5129 Thumb, index, ring and little. 5130 Thumb, middle, ring and little. THE WRIST AND HAND 5131 Index, middle, ring and little. Three digits of one hand, amputation of: 5214 Wrist, ankylosis. 5132 Thumb, index and middle. 5215 Wrist, limitation of motion of. 5133 Thumb, index and ring. 5216 Five digits of one hand, unfavorable ankylosis of. 5134 Thumb, index and little. 5217 Four digits of one hand, unfavorable ankylosis of. 5135 Thumb, middle and ring. 5218 Three digits of one hand, unfavorable ankylosis of. 5136 Thumb, middle and little. 5219 Two digits of one hand, unfavorable ankylosis of. 5137 Thumb, ring and little. 5220 Five digits of one hand, favorable ankylosis of. 5138 Index, middle and ring. 5221 Four digits of one hand, favorable ankylosis of. 5139 Index, middle and little. 5222 Three digits of one hand, favorable ankylosis of. 5140 Index, ring and little. 5223 Two digits of one hand, favorable ankylosis of. 5141 Middle, ring and little. 5224 Thumb, ankylosis of. Two digits of one hand, amputation of: 5225 Index finger, ankylosis of. 5142 Thumb and index. 5226 Middle finger, ankylosis of. 5143 Thumb and middle. 5227 Finger, any other, ankylosis of. 5144 Thumb and ring. 5145 Thumb and little. THE HIP AND THIGH 5146 Index and middle. 5147 Index and ring. 5148 Index and little. 5250 Hip, ankylosis of. 5149 Middle and ring. 5251 Thigh, limitation of extension of. 5150 Middle and little. 5252 Thigh, limitation of flexion of. 5151 Ring and little. 5253 Thigh, impairment of. 5152 Thumb, amputation of. 5254 Hip, flail joint. 5153 Index finger, amputation of. 5255 Femur, impairment of. 5154 Middle finger, amputation of. 5155 Ring finger, amputation of. THE KNEE AND LEG 5156 Little finger, amputation of. 5256 Knee, ankylosis of. AMPUTATIONS: LOWER EXTREMITY 5257 Knee, other impairment of. 5258 Cartilage, semilunar, dislocated. Thigh, amputation of: 5259 Cartilage, semilunar, removal of. 5160 Disarticulation. 5260 Leg, limitation of flexion of. 5161 Upper third. 5261 Leg, limitation of extension of. 5162 Middle or lower thirds. 5262 Tibia and fibula, impairment of. Leg, amputation of: 5263 Genu recurvatum. 5163 With defective stump. 424 VerDate 11<MAY>2000 11:56 Jul 18, 2001 Jkt 194134 PO 00000 Frm 00424 Fmt 8010 Sfmt 8002 Y:\SGML\194134T.XXX pfrm11 PsN: 194134T Department of Veterans Affairs Pt. 4, App. B [ACUTE, SUBACUTE, OR CHRONIC DISEASES] [ACUTE, SUBACUTE, OR CHRONIC DISEASES] Diag- Diag- nos- nos- tic tic Code Code No. No. THE ANKLE 5312 Group XII—Anterior muscles of the leg. 5313 Group XIII—Posterior thigh group. 5270 Ankle, ankylosis of. 5314 Group XIV—Anterior thigh group. 5271 Ankle, limited motion of. 5315 Group XV—Mesial thigh group. 5272 Subastragalar or tarsal joint, ankylosis of. 5316 Group XVI—Pelvic girdle group 1. 5273 Os calcis or astragalus, malunion of. 5317 Group XVII—Pelvic girdle group 2. 5274 Astragalectomy. 5318 Group XVIII—Pelvic girdle group 3. 5319 Group XIX—Muscles of the abdominal wall. 5320 Group XX—Spinal muscles. SHORTENING OF THE LOWER EXTREMITY 5321 Group XXI—Muscles of respiration. 5322 Group XXII—Lateral, supra and infrahyoid group. 5275 Bones, of the lower extremity, shortening of. 5323 Group XXIII—Lateral and posterior muscles of the neck. THE FOOT 5324 Diaphragm, rupture of. 5325 Muscle injury, facial muscles.
Recommended publications
  • Pycnodysostosis with a Cathepsin K Mutation: a Case Report
    Ada Medica et Biologica Vol. 49, No.l, 31-37, 2001 Pycnodysostosis with a Cathepsin K Mutation: A Case Report Hiroshi YAMAGIWA1, Mayumi ASAOKA2, Hisayoshi KATO2, Minoru SHIBATA3, and Naoto ENDO1 'Department of Orthopedic Surgery, "Rehabilitation, and 3Plastic Surgery, Niigata University School of Medicine, Niigata, Japan Received October 16 2000 ; accepted January 22 2001 Summary.Pycnodysostosis (PKND) is a type of osteo- the distal phalanges, frequent fractures, and skull sclerosing bone disease. Recent studies have demon- deformities with delayed suture closure4'5'. The cathe- strated that several cathepsin K mutations can be psin K gene, which wa cloned originally from rabbit identified in PKND families. A fifty-three-year-old Japanese womandiagnosed with PKND with typical osteoclasts6', was highly expressed in osteoclasts. features suffered from the nonunion of the right tibial This molecule plays an important role in bone resorp- shaft. We did open reduction and performed a vascular- tion and remodeling. Cathepsin K knockout mice ized fibular graft using an external fixator. A low- show impaired osteoclastic bone resorption, which intensity pulsed ultrasound device was used three leads to osteopetrosis7'8). Recent studies have demon- months after surgery. Union of the tibia was completed strated several mutations in patients with about one year after surgery. Histomorphometric anal- PKND1'9-10'11'. In this paper, we present a clinical, ysis of the iliac bone revealed that the patient had low histomorphometric, and genomic study of a patient turnover bone with increased bone volume. Analysis of with the typical form of pycnodysostosis. Since the cathepsin K coding region from the genomic DNA parental consanguinity has been noted in more than of the patient and her family (consanguineous parents 30% of cases, we also analyzed her consanguineous and three sisters who were all of normal stature) revealed that the patient had a deletion of genomic parents and three sisters.
    [Show full text]
  • Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction with Total Elbow Arthroplasty Dawn M
    (aspects of trauma • an original study) Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction With Total Elbow Arthroplasty Dawn M. LaPorte, MD, Michael S. Murphy, MD, and J. Russell Moore, MD ABSTRACT onunion occurs in 2% ing treatment option. In the 1980s, In nonunion after distal humerus to 5% of distal humerus TEA for nonunion with tightly con- fracture, osteoporosis, devas- fractures.1 The condition strained or custom prostheses had cularized fracture fragments, is difficult to treat, and fair to moderately good results but and periarticular fibrosis limit Nno single treatment modality has a high complication rates (4/7, 57%6; potential reconstructive options. high success rate with few compli- 5/14, 36%10). According to a recent We assessed pain relief, func- 2-6 11 tional gains, and complications cations. Without intervention, the review, however, 31 (86%) of 36 in 12 patients whose long-stand- patient is left with a painful, unstable, patients had a satisfactory result with ing, painful nonunions after previ- and often flail extremity and with a semiconstrained prosthesis, and ous treatment with rigid internal limitations in activities of daily liv- only 7 (19%) of the 36 patients had fixation were reconstructed with ing. Frequently, there is an associ- complications. a semiconstrained total elbow ated ulnar neuropathy. Osteoporosis, In the current study, we assessed arthroplasty, frequently with a devascularized fracture fragments, outcomes (complications, symptoms, triceps-sparing approach and and periarticular fibrosis limit poten- function) after semiconstrained anterior ulnar nerve transposition. tial reconstructive options for long- TEA for long-standing distal humer- At mean follow-up of 63 months, 11 patients had good pain relief and standing distal humerus nonunions.
    [Show full text]
  • Nonunion with Bone Loss
    Nonunion with Bone Loss Tim Weber, MD Jeff Anglen, MD, FACS Original Authors; March 2004; Revised June 2006 and 2010 Etiology • Open fracture – segmental – post debridement – blast injury • Infection • Tumor resection • Osteonecrosis Classification Salai et al. Arch Orthop Trauma Surg 119 Classification Not Widely Used Not Validated Not Predictive Salai et al. Arch Orthop Trauma Surg 119 Evaluation • Soft tissue envelope • Infection • Joint contracture and range of motion • Nerve function: sensation, motor • Vasculature: perfusion, angiogram? • Location and size of defect • Hardware • General health of the host • Psychosocial resources Is it Salvageable? • Vascularity - warm ischemia time • Intact sensation or tibial nerve transection • other injuries • Host health • magnitude of reconstructive effort vs patient’s tolerance • ultimate functional outcome Priorities • Resuscitate • Restore blood supply • Remove dead or infected tissue (Adequate debridement) • Restore soft tissue envelope integrity • Restore skeletal stability • Rehabilitation Bone Loss - Initial Treatment • Irrigation and Debridement Bone Loss - Initial Treatment • Irrigation and Debridement • External fixation Bone Loss - Initial Treatment • Irrigation and Debridement • External fixation • Antibiotic bead spacers Bone Loss - Initial Treatment • ANTIBIOTIC BEAD POUCH – ANTIBIOTIC IMPREGNATED METHYL- METHACRALATE BEADS – SEALED WITH IOBAN Bone Loss - Initial Treatment • Irrigation and Debridement • External fixation • Antibiotic block spacers Beads Block Bone Loss - Initial
    [Show full text]
  • Bone Marrow Injection for Treatment of Aneurysmal Bone Cyst
    MOJ Orthopedics & Rheumatology Bone Marrow Injection for Treatment of Aneurysmal Bone Cyst Research Article Abstract Volume 5 Issue 3 - 2016 Study design: Patients had Aneurysmal bone cyst lesion that underwent to be treated by Injection of Autologous Bone Marrow Aspirates (ABM) and follow up of this case for the final results. Patients and Methods: Sixteen patients had had Aneurysmal bone cyst had been treated by ABM injections. Study have 16 patients 11 females (68.75 %) and 5 Department of Orthopedics, Faculty of Medicine, Egypt Mahmoud I Abdel-Ghany, Assistant male (31.25 %). Age ranged from 3-14 years with average age 7.5 years. Number *Corresponding author: study including 5 cases (31.25 %) with proximal femoral cyst, 9 cases (56.25 %) Professor of Orthopedic and Trauma Surgery Faculty of of injections for every patient ranged from 2-6 times with average 4.4 times. This had tibial cyst (2 distal and 7 proximal tibiea) and 2 cases (12.5 %) had proximal Medicine for Girls, Egypt, Email: humeral cyst. All patients treated by injection of Autologous Bone Marrow Aspirates which obtained from the iliac crest. The bone marrow aspirates was Received: February 26, 2016 | Published: July 29, 2016 obtained percutaneous by bone marrow aspiration needle, According to follow up X-ray during injections we decide continuity of injections. Average size of the defect was 2.3 cm. and average amount bone marrow/inj. Was 10.2 cc. Results: Pain Score according to VAS ranged from 3-9 with average 5.7 which was improved to average 1.5 at final follow up.
    [Show full text]
  • Brown Tumour in the Cervical Spine : Case Report and Review of Literature
    http://crcp.sciedupress.com Case Reports in Clinical Pathology 2019, Vol. 6, No. 1 CASE REPORT Brown tumour in the cervical spine : Case report and review of literature S Carta1, A Chungh1, SR Gowda∗1, E Synodinou2, PS Sauve1, JR Harvey1 1Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, UK 2Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, UK Received: September 16, 2019 Accepted: October 18, 2019 Online Published: October 30, 2019 DOI: 10.5430/crcp.v6n1p27 URL: https://doi.org/10.5430/crcp.v6n1p27 ABSTRACT Background: Brown tumour of the cervical spine is very rare and is formed due to focal altered bone remodelling secondary to persistent and uncontrolled primary or secondary hyperparathyroidism. It is considered an extreme form of osteitis fibrosa cystica that occurs in the settings of persistently elevated parathyroid hormone. Case Report: This a unique lesion presented in a 48 year old male with recurrent bone pain and known End Stage Renal Disease (ESRD) on maintenance haemodialysis. The main clinical complaints were weak and painful legs and the initial presentation was after the patient collapsed at home and fractured spinal level C2. The initial assessment included blood tests and radiological imaging. CT scanning of the spine revealed a destructive lytic lesion with loss of height and architectural changes of the C2 vertebral body and cord compression. The differentials included an acute fracture, a metastatic lesion and Brown’s tumour. Further imaging with an MRI of the spine and PET-CT were performed which confirmed the above lesion and excluded metastatic disease and bone marrow infiltration.
    [Show full text]
  • General Principles in the Assessment and Treatment of Nonunions
    General Principles in the Assessment and Treatment of Nonunions Jaimo Ahn, MD, PhD & Matthew Sullivan, MD Revised February 2017 Previous Authors: Peter Cole, MD; March 2004 Matthew J. Weresh, MD; Revised August 2006 Hobie Summers, MD & Daniel S. Chan MD; Revised April 2011 Definitions • Nonunion: (reasonably arbitrary) – A fracture that is not currently healed and is not going to • Delayed union: – A fracture that requires more time than usual to heal – Shows healing progress over time Definitions • Nonunion: A fracture that is a minimum of 9 months post occurrence and is not healed and has not shown radiographic progression for 3 months (FDA 1986) • Not pragmatic – Prolonged morbidity – Narcotic abuse – Professional and/or emotional impairment Definitions (pragmatic) • Nonunion: A fracture that has no potential to heal without further intervention All images unless indicated: Rockwood and Green's Fractures in Adults, 8th Edition 2015 Classification 1. Hypertrophic 2. Oligotrophic 3. Atrophic = Avascular 4. Pseudarthrosis Weber and Cech, 1976 Hypertrophic • Vascularized • Callus formation present on x-ray • “Elephant’s foot” - abundant callus • “Horse’s hoof” - less abundant callus Biology is more than sufficient but can’t consolidate likely need mechanically favorable solution Oligotrophic • Some/minimal callus on x-ray – Not an aggressive healing response, but not completely void of biologic activity • Vascularity is present on bone scan Is there sufficient biology / mechanics for healing? Atrophic • No evidence of callous formation
    [Show full text]
  • Nonunions: Evaluation 10022 and Treatment
    10022 CHAPTER 22 Nonunions: Evaluation 10022 and Treatment ......................................................... Mark R. Brinker, M.D. and Daniel P. O’Connor, Ph.D. a fracture that, in the opinion of the treating physician, s0010 INTRODUCTION shows slower progression to healing than anticipated and p0010 While fracture nonunions may represent a small percent- is at risk of nonunion without further intervention. age of the traumatologist’s case load, they can account for To understand the biological processes and clinical impli- p0070 a high percentage of a surgeon’s stress, anxiety, and frustra- cations of fracture nonunion, an understanding of the normal tion. Arrival of a fracture nonunion may be anticipated fracture healing process is required. The following section following a severe traumatic injury, such as an open fracture reviews the local biology of fracture healing, requirements with segmental bone loss, but may also appear following a for fracture union, and types of normal fracture repair. low-energy fracture that seemed destined to heal. p0020 Fracture nonunion is a chronic medical condition asso- FRACTURE REPAIR ciated with pain and functional and psychosocial disabil- s0030 180 ity. Because of the wide variation in patient responses Fracture repair is an astonishing process that involves p0080 to various stresses177 and the impact that may have on the spontaneous, structured regeneration of bony tissue and patient’s family (relationships, income, etc.), these cases restores mechanical stability. The process begins at the are often difficult to manage. moment of bony injury, initiating a proliferation of tissues p0030 Some 90 to 95 percent of all fractures heal without pro- that ultimately leads to healing.
    [Show full text]
  • Pycnodysostosis with Special Emphasis on Dentofacial Characteristics
    Hindawi Publishing Corporation Case Reports in Dentistry Volume 2015, Article ID 817989, 6 pages http://dx.doi.org/10.1155/2015/817989 Case Report Pycnodysostosis with Special Emphasis on Dentofacial Characteristics Aisha Khoja, Mubassar Fida, and Attiya Shaikh Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan Correspondence should be addressed to Aisha Khoja; [email protected] Received 24 August 2015; Revised 24 October 2015; Accepted 2 November 2015 Academic Editor: Miguel de Araujo´ Nobre Copyright © 2015 Aisha Khoja et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pycnodysostosis is an autosomal recessive disorder that manifests as osteosclerosis of the skeleton due to the defective osteoclasts mediated bone turnover. The diagnosis of this disorder is established on the basis of its characteristic features and mustbe differentially diagnosed with other bone disorders. Dental surgeons should be aware of the limitations and possible adverse oral complications such as osteomyelitis of bone in these patients. This will guide them in planning realistic treatment goals. This paper reports the clinical and radiographic features of pycnodysostosis with the great emphasis on its dentofacial characteristics. The aim of this case report is to give an insight into the etiology, pathogenesis, and differential diagnosis of this disorder and to prepare the dentists and maxillofacial surgeons to overcome the challenges in treating these patients. 1. Introduction Dental surgeons should be familiar of the classic features of this disorder in order to establish correct and timely Pycnodysostosis is a rare genetic disorder of the bone diagnosis especially when they are the first to encounter these caused by a mutation in the gene that codes the enzyme patients.
    [Show full text]
  • Percutaneous Reaming of Simple Bone Cysts in Children Followed by Injection of Demineralized Bone Matrix and Autologous Bone Marrow Anastasios D
    ORIGINAL ARTICLE Percutaneous Reaming of Simple Bone Cysts in Children Followed by Injection of Demineralized Bone Matrix and Autologous Bone Marrow Anastasios D. Kanellopoulos, MD,* Christos K. Yiannakopoulos, MD,* and Panayiotis N. Soucacos, MD† form in response to venous congestion of the intramedullary Abstract: The authors report the successful treatment of 19 patients space. The latter theory has been supported by others who (mean age 10 years) with active unicameral bone cysts using were able to achieve cyst healing, restoring the venous circu- a combination of percutaneous reaming and injection of a mixture of lation simply by performing multiple perforations.5,9–12 demineralized bone matrix and autologous bone marrow. Follow-up Various treatment modalities have been proposed, ranging ranged from 12 to 42 months (mean 28 months). All patients were from subtotal resection to normal saline injection. The reported asymptomatic at the latest follow-up. Two required a second inter- results are puzzling, since the aggressiveness of the lesions vention to accomplish complete cyst healing. Radiographic outcome treated is rarely defined.9,10,13–20 was improved in all patients according to the Neer classification at the Scaglietti15 described a methylprednisolone injection latest follow-up. There were no significant complications related to technique, reporting a 15% to 88% recurrence rate after an the procedure, nor did any fracture occur after initiation of the above average of three injections. Superior results were reported regimen. using an osteoinductive preparation consisting of demineral- 13,14,21 Key Words: bone marrow, unicameral bone cyst, demineralized bone ized bone matrix (DBM) and autologous bone marrow.
    [Show full text]
  • Management Strategy for Unicameral Bone Cyst
    Management of unicameral bone cyst MANAGEMENT STRATEGY FOR UNICAMERAL BONE CYST Chin-Yi Chuo, Yin-Chih Fu, Song-Hsiung Chien, Gau-Tyan Lin, and Gwo-Jaw Wang Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re-fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula) managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts. Key Words: unicameral bone cyst, UBC, simple bone cyst, SBC, cannulated screw (Kaohsiung J Med Sci 2003;19:289–95) The unicameral bone cyst (UBC) or simple bone cyst The treatment of UBC includes: conservative (SBC) is encountered in the pediatric age group, with management to allow spontaneous healing during the majority of cases occurring in the first two decades puberty; curettage and grafting with autogenous or of life — with most around the age of 12 years [1,2].
    [Show full text]
  • The Generalized Type, However, Has Received
    THE GENERALIZED TYPE OF OSTEITIS FIBROSA CYSTICA VON RECKLINGHAUSEN'S DISEASE JOHN J. MORTON, M.D. Assistant Professor of Surgery, Yale University School of Medicine NEW HAVEN, CONN. INTRODUCTION The localized form of osteitis fibrosa, especially in its relation to the formation of bone cysts, has been very commonly recognized and com- mented upon during the last twenty years. Bloodgood,1 in numerous publications, and also Barrie,2 Silver,3 and Meyerding,4 have furnished valuable contributions to the American literature; and Elmslie5 has given a good summary of the English cases. The Germans have written at length on the subject. The generalized type, however, has received scant attention, possibly because it is not recognized; and, aside from the article by L\l=o"\tsch,6 no extensive publication has been devoted entirely to this form of the disease, although both Meyerding and Elmslie discuss the generalized cases in their papers. It seemed worth while, therefore, to report the subjoined case: first, because of the rarity of the condition, especially in the United States, and secondly, because of the possibility of correcting some of the deformities arising in this disease. At the same time, it was considered advisable to collect the reports of general types of the disease in order to find what might be learned from them. report of case History.—A man, aged 23, a lathe operator, was referred, Nov. 14, 1919, by Dr. Stanley Cox of Holyoke, Mass., complaining of bowing of the thigh bones. Except for the usual children's diseases, the history was essentially negative.
    [Show full text]
  • Orthognathic Surgery in Pycnodysostosis: a Case Report
    110 Herna´ndez-Alfaro et al. Case Report Congenital Craniofacial Deformities F. Herna´ndez-Alfaro1, J. Arenaz Bu´ a2, M. Serra Serrat3, Orthognathic surgery in J. Mareque Bueno1 1Department Oral and Maxillofacial Surgery Teknon Medical Center, Barcelona, Spain; pycnodysostosis: a case report 2Department of Oral and Maxillofacial Surgery, Complejo Hospitalario Universitario de A Corun˜a, Spain; 3Orthodontist, Barcelona, Spain F. Herna´ndez-Alfaro, J. Arenaz Bu´a, M. Serra Serrat, J. Mareque Bueno: Orthognathic surgery in pycnodysostosis: a case report. Int. J. Oral Maxillofac. Surg. 2011; 40: 106–123. # 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. Pycnodysostosis is an extremely rare genetic osteosclerosis caused by cathepsin K deficiency. It is a human autosomal recessive genetic disorder characterized mainly by osteosclerosis of the skeleton due to decreased bone turnover. It is characterized by short stature, brachycephaly, short and stubby fingers, open cranial sutures and fontanelle, and diffuse osteosclerosis. Multiple fractures of the long bones and osteomyelitis of the jaw are frequent complications. The authors describe an 18-year-old girl with a clinical and radiological diagnosis of pycnodysostosis and the ortho-surgical treatment undertaken. Bimaxillary orthognathic surgery was carried out using rigid fixation and bone grafts. The authors recommend bimaxillary orthognathic surgery as a choice for treating the dentofacial deformities of pycnodysostosis, emphasizing the good and stable results Accepted for publication 19 July 2010 obtained in terms of facial aesthetics and occlusion. Available online 21 August 2010 Pycnodysostosis is a rare osteopetrotic nodysostosis are abnormally dense and narrowing of the airway1–3,5–7,10.
    [Show full text]